Locking plate versus external fixation for type C distal radius fractures: A meta-analysis of randomized controlled trials

Abstract

PurposeDistal radial fracture is one of the most common fractures. Up to now, locking plates (LP) and external fixation (EF) are two conventional surgical approaches to type C radius fracture. Which method is superior has not yet reached a consensus. We try to assess the clinical effectiveness of the two interventions by this meta-analysis.MethodsWe used network to search the PubMed, Embase, and Cochrane Medical Library of randomized controlled clinical trials about the type C distal radius fractures performed according to the search strategy mentioned in Cochrane Handbook 5.1.0 from Jan. 2005 to Jan. 2016. Patients in the experimental group were used LP, in the control group were included EF and other surgical approaches. Publication language was restricted to English. Studies that patient population and surgical indication did not define had been excluded. Studies must report at least one of the outcomes as follow: radial inclination, palmar tilt, ulnar variance, range of wrist flexion and extension, and range of wrist supination and pronation. The trials in which participants included children were excluded. We used Jadad study scores to appraise the study.ResultsSeven studies included 162 patients (LP group) and 190 patients (EF group). We compared the radial inclination, palmar tilt, ulnar variance, range of wrist flexion and extension, and range of wrist supination and pronation. The radial inclination were revealed a difference favoring LP over EF [WMD = 1.84, 95% CI (0.17, 3.50), p = 0.03] and the palmar tilt and ulnar variance was no significant difference between the two groups [(WMD = 3.61, 95% CI (0.00, 7.23), p = 0.05; WMD = 0.05, 95% CI (−0.99, 1.09), p = 0.93]. The functional activities of range of flexion and extension and range of supination and pronation between the two groups was no difference [WMD = 10.04, 95% CI (−6.88, 26.96), p = 0.24; WMD = 12.53, 95% CI (−9.99, 35.06), p = 0.28].ConclusionLocking plate and external fixation is feasible to heal radius type C fracture. We found the small difference between the two groups on imaging examination. The locking plate has the advantage on maintaining reduction, however no significant difference regarding outcomes has been found between the two groups.

Treatment outcomes of applying external fixator on distal radius fractures: a randomized clinical trial to compare between two directions of force exertion in parallel to radius shaft and perpendicular to the distal radius articular surface

“…Previous research has demonstrated that this is accomplished by accurately reducing normal radial inclination, radial height, and volar tilt, and as a result, radial articular step with reduction of the distal radioulnar joint in intra-articular fractures [38,39]. When compared with lockig plate, the radiological examination revealed that the BEF group had a poorer radial inclination [7].…”

“…Previous research has demonstrated that this is accomplished by accurately reducing normal radial inclination, radial height, and volar tilt, and as a result, radial articular step with reduction of the distal radioulnar joint in intra-articular fractures [ 38 , 39 ]. When compared with lockig plate, the radiological examination revealed that the BEF group had a poorer radial inclination [ 7 ].Comparing dynamic EF with static bridging or non-bridging EFs, no notable anatomic or clinical difference was found [ 40 , 41 ]. However, the concept with developing and applying dynamic EF was early mobilization in prior research, rather than optimizing the force direction.…”

“…To treat DRF, there is a major shift from external to open fixation procedures [3], despite the absence of strong evidence in favor of improvement in clinical and functional outcomes with open fixation [4][5][6]. There is this metaanalysis found no significant difference in clinical outcomes between C-type DRF managed with locking plates and external fixators (EF) [7]. External fixation of distal radius fractures is advantageous in circumstances where soft tissue loss, wound contamination, and concomitant medical conditions make internal fixation procedures ineffective [8].…”

A Prospective Observational Clinical and Radiological Study of a Modular Bridging External Fixator for Unstable Distal Radius Fractures

“…External fixation (EF) is a valid and simple method used for fixing unstable DRFs. A recent meta-analysis has shown that there were no significant different clinical outcomes in AO/OTA C-type managed with locking plates, compared with EF 10 . Modular external bridging fixator has replaced the previous fixed bridging, ensuring rapid mobilisation 11 .…”